Pediatric Care Requirements and Hospital
Preparedness Program: New 2017
Cooperative Agreement
AND
CMS Emergency Preparedness Rules Related to
Pediatric Care
May 23rd, 2017
Teresa Ehnert| Chief-Bureau of Public Health Emergency
Preparedness
AGENDA
 Review of Pediatric Care Requirements for the Hospital
Preparedness Program (HPP) in New 2017 Cooperative
Agreement
 Review of CMS Rules Related to Children/Pediatric Care
 Discussion on collaboration between HPP and
Emergency Medical Services for Children (EMSC)
 OPEN DISCUSSION
Pediatric Care Requirements
HPP-2017 Cooperative Agreement and CMS Requirements
Goal
The goal is to understand 2017 Cooperative
Agreement and HPP Requirements related
to Health Care Coalition (HCC), Pediatric
Care and Emergency Medical Services for
Children (EMSC)
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 1 Strategy: Strengthen Community Resilience
Activity 1: Partner with Stakeholders by Developing and Maturing Health
Care Coalitions
HPP Requirements: Identify HCC Members
Awardees and HCCs should expand HCC membership to include
additional types of members ……..
HCCs also should include specialty patient referral centers such as
pediatric, burn, trauma, and psychiatric centers, as HCC members within
its geographic boundaries. They may also serve as referral centers to
other HCCs where that specialty care does not exist.
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 1 Strategy: Strengthen Community Resilience
Activity 2: Characterize the Probable Risks to the Jurisdiction and the HCC
Joint Requirements-Jurisdictional Risk Assessments
HPP Requirements: Assess Hazard Vulnerabilities and Risks
Each awardee-funded HCC must complete an annual hazard vulnerability
analysis (HVA) to identify and plan for risks, in collaboration with the awardee.
• The assessment components should address population
characteristics, including demographics, and consider those
individuals who might require additional help in an emergency
including children, pregnant women, seniors, and individuals with
access and functional needs, including people with disabilities and
others with unique needs.
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 1 Strategy: Strengthen Community Resilience
Activity 3: Characterize Populations at Risk
HPP Requirements : HPP awardees and HCCs must obtain de-identified data
from the U.S. Department of Health and Human Services emPOWER map every
six months to identify populations with unique health care needs …
As part of inclusive planning for populations at risk conducted by HPP awardees,
HPP-funded HCCs must:
• Support public health agencies with situational awareness and information
technology (IT) tools already in use that can help identify children, seniors,
pregnant women, people with disabilities, and others with unique needs
PHEP Requirements :
• To address the needs of infants and children, awardees should collaborate
with child-serving institutions such as schools and daycare centers to assure
crisis preparedness plans are in place.
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 2 Strategy: Strengthen Incident Management
Activity 4: Ensure HCC Integration and Collaboration with Emergency
Support Function-8 (ESF-8)-HCC Response Plan
Each HCC funded by the awardee must develop a response plan that is informed
by its members’ individual emergency operations plans and submit the plan to
ASPR by the end of Budget Period 2 with annual progress reports.
Each HCC’s response plan must clearly outline:
• Activation and notification processes for initiating and implementing medical
surge response coordination among HCC members and other topics related
to medical surge, including:
 Strategies to implement if the emergency overwhelms regional
capacity or specialty care including trauma, burn, and pediatric
capability.
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 3 Strategy: Strengthen Information Management
Activity 2. Share Emergency Information and Warnings across Disciplines,
Jurisdictions, and HCCs and their Members
Joint Requirements: Coordinate Emergency Information Sharing between
Public Health and Health Care.
The following are factors that HCCs, in coordination with HPP and PHEP
awardees and other public health agency members, should consider
when developing processes and procedures to rapidly acquire and share
clinical knowledge.
• Processes and procedures should address a variety of emergencies
such as chemical, biological, radiological, nuclear, or explosive
(CBRNE), trauma, burn, pediatrics, or highly infectious disease
outbreaks
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 5 Strategy: Strengthen Surge Management
Activity 2: Address Surge Needs
Joint Requirements: Family Reunification
During a public health incident or crisis, families are at risk for becoming
disconnected. HPP awardees and HCCs must serve as planning resources
and SMEs to PHEP awardees and public health agencies as they develop
or augment existing response plans for affected populations, including
mechanisms for family reunification. These plans should give
consideration to:
• Reunification considerations for children
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 5 Strategy: Strengthen Surge Management
Activity 4: Address Specialty Surge
HPP Requirements: Pediatric Care
HPP awardees must collaborate with the EMSC program within its
jurisdiction to better meet the needs of children receiving emergency
medical care. Following are specific areas of collaboration:
The HRSA administer the EMSC program at the federal level, and
this program works to ensure that critically ill and injured children
receive optimal pediatric emergency care.
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
Domain 5 Strategy: Strengthen Surge Management
Activity 4: Address Specialty Surge
HPP Requirements: Pediatric Care (Contd.)
Following are specific areas of collaboration.
• HPP and the EMSC program awardees within their jurisdictions must provide
a joint letter of support indicating that EMSC and HPP are linked at the
awardee level.
• HPP awardees must provide the initial letter of support with their funding
applications at the beginning of each budget period throughout the five-year
project period.
• HPP awardees must work with HCCs and EMSC to ensure that all hospitals
are prepared to receive, stabilize, and manage pediatric patients.
At the end of each budget period, HRSA will provide HPP with data regarding
each hospital’s capability to manage pediatric medical emergencies to assist
with this work.
Pediatric Care Requirements for HCC
HIGHLIGHTS-2017 Cooperative Agreement
HPP Evaluation and Performance Measurement Strategy
To measure and evaluate HPP performance, a variety of measures were
developed at the input-, activity-, output-, or outcome-level. The 2017-2022 HPP
performance measures target output and outcome measures to address the
information needs of various stakeholders.
One of the 22 HPP performance measures and the six measures
(23-28) for select U.S. territories and freely associated states is:
• Percent of hospitals with an Emergency Department (ED)
recognized through a statewide, territorial, or regional
standardized system that are able to stabilize and/or manage
pediatric medical emergencies.
Pediatric Care Requirements
CMS Emergency Preparedness Rule 2016
Comments on CMS EP Rules for Pediatric Care and CMS Response:
Comment-1: Joint Guidelines for Care of Children in the Emergency Department,
developed by the American Academy of Pediatrics, the American College of Emergency
Physicians, and the Emergency Nurses Association, as a resource for the final rule.
Response to Comment 1: …We also want to thank commenters for their
recommendations for additional resources on emergency preparedness. We
provided an extensive list of resources in the proposed and have included links to
various resources in this final rule that facilities can use as resources during the
development of their emergency preparedness plans. However, we note that
these lists are not comprehensive,…… since we intend to allow facilities flexibility
as they implement the emergency preparedness requirements….Omissions from
the list of resources set out in the proposed rule do not indicate any intention on
our part to exclude other resources from use by facilities.
Pediatric Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-2: A commenter recommended that emergency
preparedness plans should account for children's special needs
during an emergency. The commenter stated that emergency
preparedness plans should include children's medication and medical
device needs, challenges regarding patient transfer for neonatal and
pediatric intensive care patients, and issues involving behavioral
health and family reunification.
Comment-3: A commenter recommended that CMS collaborate
closely with the Emergency Medical Services for Children (EMSC)
program administered by the Health Resources and Services
Administration (HRSA). The commenter noted that this program
focuses on improving the pediatric components of the EMS system.
Pediatric Care Requirements
CMS Emergency Preparedness Rule 2016
Response to Comment 2 & 3: We appreciate the commenter's
concerns. As required in § 482.15(a)(1), (2), and (3), when a
provider or supplier develops an emergency preparedness plan,
we will expect that the provider/supplier will use a facility-based
and community-based risk assessment to develop a plan that
addresses that facility's patient population, including at-risk
populations. If the provider serves children, or if the majority of
its patient population is children, as is the case for children's
hospitals, we will expect the provider to take into account
children's access and functional needs during an emergency or
disaster in its emergency preparedness plan.
Pediatric Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-4: A commenter recommended that we include the Joint Guidelines for Care
of Children in the Emergency Department, developed by the American Academy of
Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses
Association, as a resource for the final rule.
Response to Comment 4: At § 482.15(a)(3), we proposed that a hospital's emergency
plan address its patient population, including, but not limited to, persons at-risk. We also
discussed in the preamble of the proposed rule that “at-risk populations” are individuals
who may need additional response assistance, including those who have disabilities, live
in institutionalized settings, are from diverse cultures, have limited English proficiency or
are non-English speaking, lack transportation, have chronic medical disorders, or have
Start Printed Page 63875pharmacological dependency.
According to the section 2802 of the PHS Act (42 U.S.C. 300hh-1) as added by
Pandemic and All-Hazards Preparedness Act (PAHPA) in 2006, in “at-risk individuals”
means children, pregnant women, senior citizens and other individuals who have
special needs in the event of a public health emergency as determined by the
Secretary.
Pediatric Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-5: A commenter stated that it could be difficult for children's hospitals to
maintain a comprehensive list of people and entities, as required for a hospital's
communication plan. The commenter gave an example of a hospital that maintains a
listing for most managers Start Printed Page 63884and above, but not for all general
staff and volunteers.
Response to Comment 5: …We disagree with the commenters who suggested that it
would be overly burdensome for hospitals to maintain a current contact list. As a best
practice, most hospitals maintain an up-to-date list of their current staff for staffing
directories and human resource management. In addition, most hospitals have
procedures or systems in place to handle their roster of volunteers. We believe that a
hospital would have a comprehensive list of their staff, given that these lists are
necessary to maintain operations and formulate a payroll.....
Furthermore, we clarify that we are not requiring hospitals to include in their
communication plan contact information for the families of staff, or the families of
patients who are not directly involved in the patient's care, or contractors not
currently providing services under arrangement.
Pediatric Care Requirements
CMS Emergency Preparedness Rule 2016
Comment-6: A commenter recommended that CMS consider
including non-healthcare facilities in the communication plan, such
as child care programs and schools, where children with disabilities
and other access and functional needs may be sheltering in place.
Response to Comment 6: We do not believe that it is appropriate
to require hospitals to include other providers of services, such as
child care programs and schools, in their communication plan in
these conditions of participation. However, we have allowed
facilities the flexibility and the discretion to include such providers
in their communication plans if deemed appropriate for that facility
and patient population.
CMS EMERGENCY PREPAREDNESS NEW RULE:
RESOURCES AND ADHS-BPHEP TECHNICAL ASSISTANCE
IMPORTANT LINK
 2017 Performance Measures: 2017-2022 HPP Performance Measures
Implementation Guidance
 ASPR-TRACIE: https://asprtracie.hhs.gov/
 Medicare and Medicaid Programs; Emergency Preparedness
Requirements for Medicare and Medicaid Participating Providers and
Suppliers
https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-andmedicaid-programs-emergency-preparedness-requirements-for-medicare-andmedicaid
THANK YOU
Teresa Ehnert| Chief-Bureau of Public Health Emergency Preparedness
[email protected] | 602-364-3571
azhealth.gov
@azdhs
facebook.com/azdhs